Injured Hamstrings And Orthotic Support

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Injured Hamstrings
And Orthotic Support
B Y W I L L I A M M . A U S T I N , D C , C C S P, C C R D
Hamstring Functioning
The hamstring group is made
up of three muscle masses that
originate from the ischial tuberosity. The medial two are the semitendinosus and the semimembranosus muscles. The biceps femoris
muscle runs along the lateral side
of the posterior thigh. Proper
function of all three is very important for gait efficiency and stability
of the knee joint.
The main functions of the hamstrings are to:
• control knee extension by the
quadriceps
• extend the hip joint, and
• flex the extended knee joint
When the quadriceps muscles
extend the knee joint, the hamstrings act as a brake to slow forward movement of the tibia. This
S
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requires an eccentric (lengthening)
contraction of the hamstring muscles. Quadriceps muscles that are
too powerful can overwhelm the
hamstrings, resulting in a sudden
muscle tear during a strenuous
activity, such as sprinting.4
Levels of Activity
During running, the hamstrings
are most active during the last 25%
of the swing phase, and the first
50% of the stance phase.5 This first
half of stance phase consists of
heel strike and maximum pronation. The leg muscles, including
the hamstrings, function to control
the knee and ankle at heel strike
and to help absorb some of the
impact. A 1999 study showed a
significant decrease in electromyographic activity in the hamstrings
when wearing orthotics.6 In fact,
the biceps femoris had the greatest
decrease in activity of all muscles
tested, which included the tibialis
anterior, the medial gastrocnemius, and the medial and lateral
vastus muscles. Previous studies
had already demonstrated a significant decrease in tibial internal
rotation 7 and on pronation velocity 8 when using orthotics. The
researchers theorized that the
additional support from the orthotics helped the hamstrings to control the position of the knee and to
absorb some of the shock of heel
strike.
Caring for and Preventing Hamstring
Injuries
The best way to treat any injury
is to prevent it from happening in
the first place. However, when an
athlete presents with a hamstring
injury, acute care and return to
sports activities are top priority.
The final stage, though, must consider the need for custom-made
orthotics in order to reduce hamstring stress and prevent re-injury.
Acute care. Hamstring injuries are
best treated with the PRICE formula: protection for the injured
muscle (an elastic wrap helps prevent further injury); rest from
strenuous activities; icing to
reduce inflammation, swelling,
and pain; compression to decrease
bleeding and congestion; and elevation to encourage drainage and
prevent lymphatic stasis. Passive
stretching and lengthening should
be started as soon as tolerable to
prevent the muscle injury from
healing in a shortened position.
Adjustments and muscle balancing. Pelvic and spinal misalignments and dysfunctions are commonly found in association with
hamstring strains. Because there is
often no way to tell whether muscular strain affected the pelvis and
spine, or vice versa, both areas
must be treated for a complete
response. Additionally, pre-existing muscle imbalances may contribute to hamstring strains. The
gluteus maximus muscle is often
relatively weak, causing the hamstring to work harder to extend the
hip joint. This may be found along
with an iliopsoas muscle that is
shortened or hypertonic on the
same side. The tightness of the
iliopsoas inhibits the gluteus maximus, thereby placing the hamstring at a disadvantage.9
Orthotic Support
A custom-made, flexible foot
45
ORTHOTIC ADVISOR
T
he most common muscle strains athletes experience are hamstring
injuries. Of the three
hamstring muscles, the biceps
femoris is most often involved.1,2
Hamstring injuries can be caused
by several factors, all of which
respond well to chiropractic care.
Sadly, many people attempt to
treat their own hamstring problems, which can lead to chronic
conditions.
Hamstring muscle imbalances
often contribute to (or may be
caused by) pelvic malpositions
and spinal subluxations.3 Chiropractic care for hamstring injuries
should include a lower extremity
postural evaluation, since custommade orthotic support may be
required, especially for rearfoot
function.
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orthotic that helps to position the
rearfoot at heel strike, absorbs
some (or most) of the impact, and
reduces overpronation can speed
healing from a hamstring injury
and reduce the possibility of recurrence. Therefore, an important
component must be a varus wedge
(or pronation correction) under the
calcaneus. The use of man-made
viscoelastic materials (such as Zorbacel®) under the heel is needed
to decrease the shock wave transmission up the leg. And finally,
sufficient support for the arches of
the foot (especially the medial longitudinal arch) must be included
to prevent prolonged pronation in
the first half of the stance phase.
An orthotic that incorporates all of
these factors should be provided
to athletes who want to return to
full participation in their sport.
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The electromyography investigations have shown that the use of
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hamstring muscles. By significantly reducing the strain of running, a
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About the Author
An enthusiastic speaker, Dr. William
Austin provides an energetic approach
to learning. He draws from over 35
years of healthcare experience, which
includes athletic training, emergency
medicine, English bonesetting, and
chiropractic. Dr. Austin has developed
two successful practices. His patients
range from newborns to centenarians,
couch potatoes to professional athletes.
Dr. Austin is a 1986 graduate of Logan
College of Chiropractic, and is currently Director of Professional Education
at Foot Levelers, Inc. of Roanoke, VA.
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